WQ0040422_Application_20181114

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WQ0040422
October 19, 2018
To: Timothy Heim, Engineer
Department of Environmental Quality
Division of Water Resources
2090 US Hwy. 70
Swannanoa, NC 28778
Phone: [phone]
Email: [e-mail]
From: Christopher H. Waller, Professional Engineer
P.O. Box 44
Collinsville, Virginia 24078
Phone: [phone]
Fax: [phone]
Email: [e-mail]
Re: FTSA for the "Sewer Extension for B-Y Hickory Plant"
Mr. Heim,
Hope all is well.
Please find attached:
NOV 8 2018
;'R'li1l1S
• One copy and one original of the properly executed FTSA for the
project listed above. All supporting documents are included.
• One check in the amount of $480.00 for the application fee.
• One executed copy of the FTSE from the City of Hickory.
• Two site maps of the project (one street level and one USGS
quad).
The purpose of this project is to install 295 linear feet of public gravity sewer
located mostly in Burke County and partly in Catawba County. This sewer
extension will service an existing furniture factory (no industrial flows) that is
currently being expanded. The current facility is tied to a sub -surface drainfield.
The plan for the site proposes to abandon that drainfield and connect to the public
system owned by the City of Hickory.
Catawba County Environmental Health reviewed and approved the
abandonment of the drainfield pending this sewer connection. Catawba County
Erosion Control and Stormwater Permitting reviewed and approved the
disturbance of the land. The City of Hickory reviewed and approved the site and
the extension of the gravity sanitary sewer. NCDOT reviewed and approved the
plan to locate this sewer extension within the limits of their right-of-way. Burke
County deferred to review the project as all construction within the county limits
fell within the limits of NCDOT's right-of-way.

This sewer extension is located along the peak of a ridge and the amount of
possible connections is limited to the factory in question and 2 residential homes.
Any other possible flows to this sewer extension would require another FTSA as
those connections would be forced to be public in nature.. Te factory expansion in
question is Bradington Young, located at 4040 10a' Ave. SW — Hickory, NC. The
factory will pump sewage to this extension through a private line that services
only their building (exempt from this application per 2T), and the 2 homes will
gravity flow to the system. All together the proposed and possible flow for this
extension is 4095 GPD.
Your time and attention is greatly appreciated. Please do not hesitate to call or
write at anytime with any comments or questions as I am at your disposal to
provide all that is required to acquire the permit required to start construction.
Respectfully,
Christopher H. Waller, PE

State of North Carolina
nWR
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources INSTRUCTIONS FOR FORM: FTA 04-16 & SUPPORTING DOCUMENTATION
This application is for sewer extensions involving gravity sewers, pump stations and force mains, or any combination that has been
certified by a professional engineer and the applicant that the project meets the requirements of 15A NCAC 02T and the Division's
Minimum Design Criteria and that plans, specifications and supporting documents have been prepared in accordance with, 15A
NCAC 02T 15A NCAC 02T .0300, Division policies and good engineering practices.
While no upfront engineering design documents are required for submittal, in accordance with 15A NCAC 02T .0305(b), design
documents must be prepared prior to submittal of a fast track permit application to the Division. This would include plans, design
calculations, and project specifications referenced in 15A NCAC 02T .0305 and the applicable minimum design criteria. These
documents shall be available upon request by the Division.
Projects that are deemed permitted (do not require a permit from the Division) are explained in 15A NCAC kT-0303.
Projects not eligible for review via the fast track process (must be submitted for full technical reviewi): n
➢ Projects that require an environmental assessment in accordance with 15A NCAC 1 C .0106;
➢ Projects that do not meet any part of the minimum design criteria (MDC) document;
➢ Projects that involve a variance from the requirements of 15A NCAC 2T; *01i
➢ Pressure sewer systems utilizing septic tank -effluent pumps (STEPS) or simplex grinder pumps B F
➢ STEP or simplex grinder pumps connecting to pressurized systems (e.g. force mains),
➢ Vacuum sewer systems. IB
General — When submitting an application, please use the following instructions as a checklist in order to ensntc 'altrequfred
items are submitted. Adherence to these instructions and checking the provided boxes will help produce a quickei'reviev/fime
and reduce the amount of requested additional information. Failure to submit all required items will necessitate additional
processing and review time, and may result in return of the application. Unless otherwise noted, the Applicant shall submit
one original and one copy of the application and supporting documentation.
A. One Original. and One Copy of Application and Supporting Documents
® Required unless otherwise noted
B. Cover Letter (Required for All Application Packages):
® List all items included in the application package, as well as a brief description of the requested permitting action.
➢ Be specific as to the system type, number of homes served, flow allocation required, etc.
➢ If necessary for clarity, include attachments to the application form.
C. Application Fee (AR New and Major Modification Application Packages):
® Submit a check or money order in the amount of $480.00 dated within 90 days of application submittal.
➢ Payable to North Carolina Department of Environmental Quality (NCDEQ)
D. Fast Track (Form: FTA 04-16) Application (Required for AR Application Packages):
® Submit the completed and appropriately executed application.
➢ If necessary for clarity or due to space restrictions, attachments to the application may be made.
❑ If the Applicant Type in Item I.2 is a corporation or company, provide documentation it is registered for business with
the North Carolina Secretary of State.
❑ If the Applicant Type in Item I.2 is a partnership or d/b/a, enclose a copy of the certificate filed with the Register of
Deeds in the county of business.
® The Project Name in Item II.1 shall be consistent with the project name on the flow acceptance letters, agreements, etc.
® The Professional Engineer's Certification on Page 5 of the application shall be signed, sealed and dated by a North
Carolina licensed Professional Engineer.
® The Applicant's Certification on Page 5 of the application shall be signed in accordance with 15A NCAC 02T .0106(b).
Per 15A NCAC 02T ,0106(c), an alternate person may be designated as the signing official if a delegation letter is
provided from a person who meets the criteria in 15A NCAC 02T .0106(b).
INSTRUCTIONS FOR FORM: FTA 04-16 & SUPPORTING DOCUMENTATION Page 1 of 3

E. Flow Tracking/Acceptance Form (Form: FTSE 04-16) (If Applicable):
® Submit the completed and executed FTSE form from the owners of the downstream sewers and treatment facility.
➢ Multiple forms maybe required where the downstream sewer owner and wastewater treatment facility are different.
➢ The flow acceptance indicated in form FTSE must not expire prior to permit issuance and must be dated less than one
year prior to the application date.
➢ Submittal of this application and form FTSE indicates that owner has adequate capacity and will not violate G.S. 143-
215.67 a .
➢ Intergovernmental agreements or other contracts will not be accepted in lieu of a project -specific FTSE.
F. Site Maps (All Application Packages):
® Submit an 8.5-inch x 11-inch color copy of a USGS Topographic Map of sufficient scale to identify the entire project
area and closest surface waters.
➢ Location of the project (gravity sewer, pump stations & force main)
➢ Downstream connection points and permit number (if known) for the receiving sewer
® include a street level map (aerial) showing general project area so that Division staff can easily locate it in the field.
G. Existing Permit (All Modification Packages):
❑ Submit the most recently issued existing permit.
❑ Provide a list of any items within the permit the Applicant would like the Division to address during the permit
modification (i.e., permit description, flow allocation, treatment facility, etc.).
H. Power Reliability Plan (Required if portable reliability option utilized for Pump Station):
❑ Per 15A NCAC 02T .0305(h)(1), submit documentation of power reliability for pumping stations.
➢ This alternative is only available for average daily flows less than 15,000 gallons per day
➢ It shall be demonstrated to the Division that the portable source is owned or contracted by the applicant and is
compatible with the station. The Division will accept a letter signed by the applicant (see 15A NCAC 02T .0106(b)) or
proposed contractor, stating that "the portable power generation unit or portable, independently -powered pumping
units, associated appurtenances and personnel are available for distribution and operation of this pump station."
➢ If the portable power source or pump is dedicated to multiple pump stations, an evaluation of all the pump
stations' storage capacities and the rotation schedule of the portable power source or pump, including travel
timeframes, shall be provided in the case of a multiple station power outage. (Required at time of certification)
1. Certificate of Public Convenience and Necessity (All Application Packages for Privately -Owned Public Utilities):
❑ Per 15A NCAC 02T .0115(a)(1) provide the Certificate of Public Convenience and Necessity from the North Carolina
Utilities Commission demonstrating the Applicant is authorized to hold the utility franchise for the area to be served by
the sewer extension, or
❑ Provide a letter from the North Carolina Utilities Commission's Water and Sewer Division Public Staff stating an
application for a franchise has been received and that the service area is contiguous to an existing franchised area or
that franchise approval is expected.
J. Operational Agreements (Applications from HOA/POA and Developers for lots to be sold):
❑ Home/Property Owners' Associations
❑ Per 15A NCAC 02T .0115(c), submit the properly executed Operational Agreement (FORM: HOA).
❑ Per 15A NCAC 02T .0115(c), submit a copy of the Articles of Incorporation, Declarations and By-laws.
❑ Developers of lots to be sold
❑ Per 15A NCAC 02T .0115(b), submit the properly executed Operational Agreement (FORM: DEV).
For more information, visit the Division's collection systems website
INSTRUCTIONS FOR FORM: FTA 04-16 & SUPPORTING DOCUMENTATION Page 2 of 3

DWR
15A NCAC 02T
Division of Water Resources
WQ0040422
Application
State of North Carolina
Department of Environmental Quality
Division of Water Resources
SEWER SYSTEM EXTENSION APPLICATION
'TA 04-16 & SUPPORTING DOCUMENTATION
(to be completed by DWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: City of Hickory (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State/County ® Municipal ❑ Other
3. Signature authority's name: Warren Wood per 15A NCAC 02T .0106(b)
Title: City Manager
4. Applicant's mailing address: PO Box 398
City: Hickory State: NC Zip: 28603-_
5. Applicant's contact information:
Phone number: [phone] Email Address: wwood(cr)hickorvnc..ov
II. PROJECT INFORMATION:
1. Project name: Sewer Extension For B-Y Hickory Plant
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project
If a modification, provide the existing permit number: W000_ and issued date:
If new construction but part of a master plan, provide the existing permit number: WQ00__
3. County where project is located: Burke/Catawba
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.714613' Longitude:-81,404986'
5. Parcel ID (if applicable): 2782-63-0772
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Christopher H. Waller License Number: 046590
Firm:
Mailing address: PO Box 44
City: Collinsville State: VA
Phone number: 276 647-3506
Zip: 24078-.
Email Address: chwaller(a)vt.edu
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Henry Fork W WTF Permit Number: NPDES - NCO040797
Owner Name: City of Hickory
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. Permit Number(s): W CSD0297 Downstream (Receiving) Sewer Size: 8 inch
System Wide Collection System Permit Number(s) (if applicable): WQCS_
Owner Name(s): City of Hickory
FORM: FTA 04-16 Page 1 of 5

►y�r.ya�� : a.� i�1 i' is a�t�.
1. If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached? ❑
❑ Yes CNo xN/A
2. If the Applicant is a Developer of lots to be sold, has a Developer's Operational Agreement (FORM: DEV) been attached?
❑ Yes ONo xN/A
3. If the Applicant is a Horne/Property Owners' Association. has an Operational Agreement (FORM: HOA) been attached?
❑ Yes CNo xN/A
4. Origin of wastewater: (check all that apply)
xResidential Owned ❑ Retail (stores, centers, malls)
❑ Residential Leased ❑ Retail with food preparation/service
❑ School / preschool/ day care ❑ Medical / dental / veterinary facilities
❑ Food and drink facilities ❑ Church
xBusinesses / offices / factories ❑ Nursing Home
❑ Car Wash
❑ Hotel and/or Motels
❑ Swinming Pool/Clubhouse
❑ Swimming Pool/Filter Backwash
❑ Other (Explain in Attachment)
5. Nature of wastewater: 100 %Domestic/Commrmercial _%Commercial
% Industrial (tSee 15A NCAC 02T .0103(20))
( - Is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Hasa flow reduction been approved under 15A NCAC 02T .0114(fl? ❑ Yes xNo
➢ If yes. provide a egZof flowreduction Koval letter
7. Summarize wastewater generated by project:
Establishment Type (see 021.0114(fl)
Daily Design Flow',"
No. of Units
Flow
Business -Factory
25gal/day/employee
135
3375J!PD
Dwelling
120 gaUday/bedroom
6
720 CZ
gal/
C PD
gall
GPD
gaV
GPD
gall
GP
Total
4095 D
a See 15A NCAC 02T .0114(b). (d),1e1(11 and (e)(2) for caveats to wastewater design flow rates (i.e., ❑minimum flow per
dwelling; proposed unknown non-residential development uses; public access facilities located near high public use
areas; and residential property located south or east of the Atlantic Intracoastal Waterway to be used as vacation rentals
as defined in G.S. 42A-4 .
b Per 15A NCAC 02T .0114(c), design flow rates for establishments not identified [in table 15A NCAC 02T.0114] shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 409V CPD (per 15A NCAC 02T 0114)
);;- Do not include future flows or previously permitted allocations
If permitted flow is zero, indicate why:
CPump Station or Gravity Sewer where flow will be permitted in subsequent permits that connect to this line
CFlow has already been allocated in Pemilt Number: _
❑ Rehabilitation or replacement of existing sewer with no new flow expected
❑ Other (Explain): _
INSTRUCTIONS FORFORM: FTA 04-16 & SUPPORTING DOCUMENTATION Page 2 of 5

VH. GRAVITYSEWER DFSIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
1. SunuYerize gravity sewer to be permitted:
Size (inches) Length (feet) Material
8 295,/ SDR 35 PVC
➢ Section 11 & III of the MDC for Permitting of Gravity Sewers contains infom ation related to design criteria
➢ Section III contains information related to mininsrmslopes for gravity sewer(s)
➢ Oversizing lines to meet minimum slope requirement is not allovred and violation of the MDC
VDI. PUMP STATION DESIGN C T RIA(ifApplicable)-02T.0305&MDC(PunStations/ForceMainsl:
COMPLErEFOR EACH PUMP STATION INCLUDED IN TIIIS PROJEC I'
1. Pump station number or name:_
2. Approximate Coordinates (Decimal Degrees): Latitude: Longitude:
3. Design flow ofthe pump station: _ millions gallons per day (firmcapacity)
4. Operationalpoint(s) of the pump(s): _ gallons per minute at — feet total dynamic head (TDIT)
5. Surm imrize the force main to be permitted (for this Pump Station):
Size (inches) Length (feet) Material
6. Power reliability in accordance with 15A NCAC 02T .0305(h)(11:
❑ Standby power source or pump with automatic activation and telemetry -15A NCAC 02T .0305(h)(1)(B);
➢ Required for all pump stations with an average daily flow greater than or equal to 15,000 gallons per day
➢ Must be permanent to facility
Or if the pump station has an average daily flow less than 15,000 gallons per day:
❑ Portable power source with manual activation, quick -connection receptacle and telemetry - 15A NCAC 02T .0305(h)(1)(C)
or
❑ Portable pumping unit with plugged emergency pump connection and telemetry -15A NCAC 02T .0305(h)(1)(C):
➢ It shall be demonstrated to the Division that the portable source is owned or contracted by the applicant (draft agreement)
and is compatible with the station.
➢ If the portable power source or pump is dedicated to multiple pump stations, an evaluation of all the pump stations'
storage capacities and the rotation schedule of the portable power source or pump, including travel timeframes, shall be
provided in the case of multiple station power outage.
INSTRUCTIONS FORFORM: FTA 04-16 & SUPPORTiNGDOCUMENTATION Page 3 of 5

IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC` 02T .0305(t)):
1. Does the project comply with all separations found in 15A NCAC 02T 0305(f) & (s)
➢ 15A NCAC 02T.0305(fl contains minimum senarations that shall he nrnvided fnr newer systems-
® Yes ❑ No
Setback Parameter*
Separation Required
Storm sewers and other utilities not listed below (vertical)
24 inches
Water mains vertical -water over sewer including in benched trenches)
18 inches
Water mains horizontal
10 feet
Reclaimed water lines vertical - reclaimed over sewer)
18 inches
Reclaimed water lines horizontal - reclaimed over sewer)
2 feet
**Any private or public water supply source, including any wells, WS-I waters of Class 1 or
Class Il impounded reservoirs used as a source of drinking water
100 feet
**Waters classified WS (except WS-I or WS-V), B, SA, ORW, HQW, or SB from normal
high water or tide elevation and wetlands see item IX.2
50 feet
**Any other stream, lake, impoundment, or ground water lowering and surface drainage
ditches
10 feet
Any building foundation
5 feet
Any basement
10 feet
Top slope of embankment or cuts of 2 feet or more vertical height
10 feet
Drainages stems and interceptor drains
5 feet
Any swimming pools
10 feet
Final earth grade (vertical)
36 inches
➢ 15A NCAC 02T 0305(e) contains alternatives where separations in 02T.0305(fl cannot be achieved.
➢ **Stream classifications can be identified using the Division's NC Surface Water Classifications webnaee
➢ if noncompliance with 02T.0305(fl or (e), see Section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation) ®Yes ❑ No ❑ N/A
➢ Seethe Division's draft separation requirements for situations where separation cannot be meet
➢ No variance is required if the alternative design criteria specified is utilized in design and construction
➢ As built documents should reference the location of areas effected
3. Does the project comply with setbacks found in the river basin rules per 15A NCAC 02B .0200? ® Yes ❑ No ❑ N/A
➢ This would include Trout Buffered Streams per 15A NCAC 213.0202
4. Does the project require coverage/authorization under a 404 Nationwide or ❑ Yes ® No
individual permits or 401 Water Quality Certifications?
➢ Information can be obtained from the 401 & Buffer Permittinp Branch
5. Does project comply with 15A NCAC 02T.0105(c)(6) (additional permits/certifications)? ® Yes ❑ No
Per 15A NCAC 02T.0I05(c)(6), directly related environmental permits or certification applications are being prepared, have
been applied for, or have been obtained. Issuance of this permit is contingent on issuance of dependent permits (erosion and
sedimentation control plans, stormwater management plans, etc.).
6. Does this project include any sewer collection lines that are deemed "high -priority?"
Per 15A NCAC 02T.0402, "high -priority sewer" means "any aerial sewer, sewer contacting surface waters, siphon, or sewer
positioned parallel to stminbanks that is subject to erosion that undermines or deteriorates the sewer.
❑ Yes ® No ❑ N/A
➢ If yes, include an attachment with details for each line, including type (aerial line, size, material, and location).
High priority lines shall be inspected by the permittee or its representative at.least once every six -months and inspections
+.. documented per 15A NCAC 02T.0403(a)(5) or the permitee's individual System -Wide Collection permit,
FORM: FTA 04-16 Page 4 of 5

X.
CERTIFICATIONS:
1. Does the submitted system comply with l5A NCAC 02T, the Minimum Design Criteria for the Permittingof f Pump Stations
and Force Mains (latest version) and the Gravity Sewer Minimum Design Criteria (latest version) as applicable?
® Yes ❑ No
If No, complete and submit the Variance/Alternative Design Request application (VADC 10-14) and supporting documents for
review. Approval of the reauest is required prior to submittal of the Fast TrackApplieatiOn and supporting documents
2. Professional Engineer's Certification:
1 (, r Sl C' Pr attest that this application for
(Professional Engineer's name from Application Item II1.1.)
has been reviewed by me and is accurate, complete and consistent with the information supplied in the plans, specifications,
engineering calculations, and all other supporting documentation to the best of my knowledge. I further attest that to the best
of my knowledge the proposed design has been prepared in accordance with the applicable regulations, Gravity Sewer
Minimum Design Criteria for Gravity Sewers (latest version), and the Minimum Design Criteria for the Fast -Track Permitting
of Pump Stations and Force Mains (latest version). Although other professionals may have developed certain portions of this
submittal package, inclusion of these materials under my signature and seal signifies that I have reviewed this material and
havejudged it to be consistent with the proposed design.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.613, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed $10,000, as well as civil penalties up to $25,000 per violation.
North Carolina Professional Engineer's seal, signature, and date:
3. Applicant's Certification per 15A NCAC 02T .0106(b):
Item 1.3.)
that this application for
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that if all required parts of
this application are not completed and that if all required supporting documentation and attachments are not included, this
application package is subject to being retuned as incomplete. I understand that any discharge of wastewater fi-om this non -
discharge system to surface waters or the land will result in an immediate enforcement action that may include civil penalties,
injunctive relief, and/or criminal prosecution. 1 will make no claim against the Division of Water Resources should a condition
of this permit be violated. 1 also understand that if all required parts of this application package are not completed and that if
all required supporting information and attachments are not included, this application package will be returned to me as
incomplete.
NOTE -- In accordance with General Statutes 143-215.6A and 143-215.6B, any person who knowingly mattes any false
statement, representation,. or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed $10,000 as well as civil penalties up to $25,000 per violation.
Signature: \ �. Date; `V (- l R
FORM: FTA 04-16 Page 5 of 5

' WQoo40422 State of North Carolina
Department of Environmental Quality
Division of Water Resources
of Water Resources ' Flow Tracking for Sewer Extension Applications
(FTSE 10-18)
Entity Requesting Allocation: City of Hickory
Project Name for which flow is being requested: Sewer Extension for B-Y Hickory Plant
More than one FTSE may be required for a single project tfthe owner of the WWTP is not responsible for all pump
stations along lire route oftheproposed wastewaterflow. f-
I. Complete this section only if you are the owner of the wastewater treatment
a. WWTP Facility Name:
b. WWTP Facility Permit
Fork WWTF
c. WWTP facility's permitted flow
d. Estimated obligated flow not yet tributary to the WWTP
e. WWTP facility's actual avg. flow
£ Total flow for this specific request
g. Total actual and obligated flows to the facility
h. Percent of permitted flow used
A11,jlows
9.0
2,63283
0.004095
4.527695
50.3%
8 2018
-:"Tuna
II. Complete this section for each pump station you are responsible for along the route of this proposed
wastewater flow.
List pump stations located between the project connection point and the WWTP:
(A)
(B}
Design
Pump
Pump
Average
Approx.
Station
Station
Firm 'Daily Flow**
Current
(Name or
Permit
Capacity, * (Firm / pt),
Avg. Daily
Number)
No.
MOD MOD
Flow, MOD
(C)
(D)=(B+C) (E)=(A-D)
Obligated,
Not Yet
Total Current
Tributary
Flow Plus
Daily Flow,
Obligated Available
MOD
Flow Capacity***
* The Firm Capacity (design flow) of any pump station is defined as the maximum pumped flow
that can be achieved with the largest pump taken out of service.
** Design Average Daily Flow is the firm capacity of the pump station divided by a peaking factor
(pf) not less than 2.5, per Section 2.02(A)(4)(c) of the Minimum Design Criteria.
*** A Planning Assessment Addendum shall be attached for each pump station located
between the project connection point and the W WTP where the Available Capacity is < 0.
Downstream Facility Name (Sewer): Swr Infrastructure Imprvmnts-Hildebran
Downstream Permit Number: WQCSD0297
Page I of 6
FTSE 10-18

III. Certification Statement:
I Warren Wood, City Manager certify to the best of my knowledge that the addition of
the volume of wastewater to be permitted in this project has been evaluated along the route to the receiving
wastewater treatment facility and that the flow from this project is not anticipated to cause any capacity
related sanitary sewer overflows or overburden any downstream pump station en route to the receiving
treatment plant under normal circumstances, given the implementation of the planned improvements
identified in the planning assessment where applicable. This analysis has been performed in accordance
with local established policies and procedures using the best available data. This certification applies to
those items listed above in Sections I and II plus all attached planing assessment addendums for which I
am the responsible party. Signature of this form certifies that the receiving collection system or treatment
works has adequate capacity to transport and treat the proposed new wastewater.
Signing
Title
POTI a
Page 2 of 6
FTSE 10-18

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